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Flashcards in CHD/ACS Deck (41)
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1

What is classic ACS initial therapy

MONA---
Morphine
Oxygen
Nitro (vasodilation)
Aspirin

2

What are atypical symptoms of ACS that women can present with

Fatigue, GI, pulmonary

3

What is angina (general)

clinical syndrome w/ chest, jaw, shoulder, or arm discomfort attributable to coronary ischemia (supply too little for demand)

4

What are the subtypes of angina

-Typical: substernal, provoked by EXERTION/stress, relieved by REST
-Atypical: may be PLEURITIC, reproduced by palpation/MOVEMENT, lasts days or seconds

5

What is stable vs unstable angina

-Stable: develops w/ EXERTION, resolves with REST. short duration
-Unstable: develops AT REST/minimal exertion. lasts longer. D/t insufficient blood flow w/o myocardial necrosis

6

What is NSTEMI/STEMI

angina w/ elevated cardiac biomarkers indicating MI
-Actual muscle is dying

7

What is NSTE-ACS

imbalance of myocardial oxygen consumption and demand causing ischemia/infarct

8

How do you characterize an MI

High or low Troponin w/ at least 1 of following:
-Sx of ischemia
-New ST-T wave changes/LBBB
-Pathologic Q waves
-Loss of myocardium/new RWMA
-Intracoronary thrombus

9

What patients would you use an ischemia guided strategy in, and what is the strategy

Low risk score (TIMI 0-2)
Extensive comorbidities
-Start on meds and plan for stress test

10

What patients would you use an early invasive strategy in, and what is it

New ST depression, elevated trop, recurrent angina, CHF
-Send to cath lab

11

What are some causes of NSTE-ACS

Atherosclerosis
Vasospasm
Coronary embolism
Dissection
Non-obstructive (HTN, anemia, hyperthyroid)

12

What are some possible findings in CHD PE

Levine's sign
New S4
Paradoxical splitting of S2
New murmur
Pericardial friction rub
CHF/shock

13

What are the 3 P's that tell you its LESS likely to be a STEMI/NSTEMI

Palpable
Positional
Pleuritic

14

What are some CAD risk factors

DM
HTN
HLD
Tobacco
sex age FHx
ESRD

15

What categorizes ST depression and T wave changes

new ST depression 5mm (0.5mV) in 2+ leads
T wave inversion 1mm in 2+ leads

16

What is the ACS early branch system

Patient comes in with ACS
EKG
Biomarkers
Risk stratify to determine approach

17

How long does it take for Troponin to elevate

2-4 hours, persists 14 days

18

What are causes of elevated troponin

Tacky/brady arrhythmia
Shock
HTN
HF
Severe PE
Sepsis
Renal failure

19

When is CKD helpful

when diagnosing reinfarction and assessing perfusion

20

What are the TIMI risks

-Age 65+
-3+ CAD RF (HTN, DM, HLD, FHx, smoking)
-CAD
-Elevated cardiac biomarker
-ASA w/in 7 days
-ST elevation
-Severe angina

21

What are admission criteria for ACS

Recurrent symptoms
Ischemic changes on ECG
Elevated troponin
TIMI 3+

22

What are standard medical therapies for NSTE-ACS

Oxygen
Anti-Platelet (ASA&P2Y12 inhibitor/)
Statins (high intensity)
Nitro
Analgesics (NO NSAIDS)

23

What is a P2Y12 inhibitor

an anti platelet given WITH ASA
Clopidogrel (Plavix)
*If possible hold clopidogrel 5 days prior to surgery

24

What are GP IIa/IIb inhibitors

Anti-platelet used WITH ASA and heparin during AMI

25

What anti-HTN med takes precedence when treating NSTE-ACS

BB- given within first 24 hours (but NOT in CHF, HB, or asthma)
If BB contraindicated, use CCB
Add CCB to BB if with persistent angina

26

What are other NSTE-ACS therapies to initiate

ACE (if LVEF <40%
ARB
Ald. Antagonist (on ACE and BB with EF <40%)

27

What are stress test options

Exercise ECG
Echo (exercise or Dobutamine)
Myocardial perfusion imaging (exercise or adenosine)
--For those with abnormal baseline ECG

28

What are the most specific and sensitive stress tests for detecting CAD

Sensitive: Vasodilator nuclear MPI
Specific: Dobutamine Echo

29

What post-hospital care should be given to patients

+/- cardiac rehab (if rule in and have MI)
TLC
Aspirin
ACE/ARB
BB

30

What are likely causes of ACS with ST elevation

AMI
STEMI
Cocaine (young w/o RF)
Vasospasm